Relocation of the Roux Limb for Weight Regain After Gastric Bypass
John L. Coon MD, FACS1; Milton Owens, MDCM, FACS2; John Sczepaniak, MD3
1 New Image Bariatric, Riverside, CA 92503
2 Coastal Center for Obesity, Orange, CA 92869
3 Sczepaniak Health and Medical Enterprises, San Diego, CA 92115
Weight regain or insufficient weight loss is common after gastric bypass. None of the surgical revisions commonly tried is particularly successful; typically producing limited or short term weight loss and a significant incidence of complications [1,2,3]. We describe here eighteen patients treated with a Roux limb transection at the entero-enterostomy and reconnection of the Roux limb back to the common channel further down the common channel. This effectively shortens the common channel and lengthens the biliopancreatic channel.
Records were reviewed on eighteen patients who had had a previous gastric bypass and insufficient weight loss. Because of that insufficient weight loss, they were revised by relocating the Roux limb from the initial entero-enterostomy to a location further down the Roux limb. Endpoints included weights and BMI’S at the time of bypass and at nadir after bypass and at nadir after revision. Also recorded were number of bowel movements/d, serum albumin, iron studies, vitamins B12, A and D. When appropriate a paired T- test was performed on Apache OpenOffice 4.1.3.
18 patients' records were reviewed 15F/3M. Average height was 64.4 in (163.7 cm stdev +/ 10.4). Average weight before gastric bypass was 288.4 lbs(130.9 kg+/ 23.1). Before revision average weight was 248.5 lbs(112.8 kg +/ 18.8, n=18). Nadir weight after revision was 202.6 lbs(92.0 kg +/ 23.7 , n=16). This is a 23.3% drop from the initial weight before the revision and brings them to 35% initial weight loss from the original gastric bypass. Patient's follow up data was available after one month for 88.9%, after three months for 77.8%, and after one year for 61.1% of patients. Average BMs/day was 5.23/day. Albumin levels dropped from 4.09 to 3.09 g/dL (p<0.05). Fasting glucose levels dropped from 99.69 to 83.00 mg/dL (p<0.05). LDL levels dropped from 107.56 to 68.43 mg/dL (p<0.05). Total cholesterol levels dropped from 187.6 to 134.29 mg/dL (p<0.05). Before revision, TSH levels were elevated in two participants and low in one. Creatinine, corrected serum calcium, serum iron, HDL, and triglyceride levels were not statistically different. No mortality or reoperations due to operative complication.
Relocation of the Roux limb to shorten the common channel, thus lengthening concurrently the BP limb, is safe and technically straight forward. By experience and from discussion with other bariatric surgeons with experience in malabsorptive bariatric surgery, we have learned that the common channel should in general be no shorter than 150 cm. The most serious adverse outcome is malnutrition. It should be noted that all patients will require oral vitamin supplementation and most will benefit from oral protein supplementation.
We would like to thank UCSD for access to reference research papers.
We would like to thank Joseph Maroge for assisting in data analysis and presentation.
We would like to thank Christina Arroyo-Tiblier for data collection.
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